Doctor Blows Whistle on Colleague, Recovers Near $45M for Medicare

October 11, 2010

A Chicago cardiologist will pay $20 million to settle whistleblower allegations that he submitted false claims to Medicare in violation of the False Claims Act, says the U.S. Attorney for the Northern District of Illinois. Dr. Sushil Sheth begins serving a 60-month prison term for the fraud this month. In addition to the $20 million dollar civil settlement, Sheth will pay $13 million in restitution and forfeit $11.3 million. The whistleblower suit was filed by one of his fellow physicians, Dr. Lokesh Chandra, who “contracted with Sheth to have him cover hospital rounds and patients when Dr. Chandra was out of town or otherwise unavailable.” According to the U.S. Attorney’s statement:

Between 2002 and 2007, Sheth submitted false claims seeking payment from Medicare and Medicaid for services at the highest level of in-patient cardiac care when, in fact, those services were not performed.
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In the criminal case, Sheth admitted using his hospital privileges to obtain information about patients without their knowledge or consent. He then hired individuals to bill Medicare and other insurance providers for medical services that he purportedly rendered to patients whom he knew he never treated. Typically waiting almost a year after the treatment was purportedly provided, Sheth submitted more than 14,800 false claims for reimbursement for providing the highest level of cardiac care — requiring hands-on treatment in an intensive care unit — on multiple days during patients’ hospital stays. Sheth regularly submitted claims seeking payment that, when added together, had him providing more than 24 hours of medical services and treatment in a single day.

Sheth’s former colleague Dr. Lokesh Chandr will receive $3.5 million for alerting the authorities to the fraud.

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